CMS Publishes Proposed Coverage Expansion for Cochlear Implants Under Medicare

CMS Publishes Proposed Coverage Expansion for Cochlear Implants Under Medicare 

7/6/2022

Proposed Criteria Expansion

We are pleased to announce that on July 6, the Centers for Medicare & Medicaid Services (CMS) published details on its proposed coverage expansion for cochlear implants.  If adopted, Medicare would broaden candidacy criteria to allow individuals with hearing test scores of >40% and ≤60%.  After reviewing the evidence submitted as part of the National Coverage Determination (NCD) process, CMS found that the evidence was sufficient to determine that cochlear implantation may be covered for a broader spectrum of hearing loss.  Specifically, CI is an appropriate treatment of bilateral pre- or post-linguistic, sensorineural, moderate-to-profound hearing loss in individuals who demonstrate limited benefit from amplification defined by test scores of less than or equal to 60% correct in the best-aided listening condition on recorded tests of open-set sentence cognition. Patients must meet other criteria defined by CMS as well.

This change was sought early on by the newly organized American Cochlear Implant Alliance with a multi-center study to explore and document outcomes in older adults who had more residual hearing than was currently allowed under Medicare coverage criteria. We approached the Centers for Medicare and Medicaid Services (CMS), requesting that they partner with us and allow Medicare expanded coverage for individuals who were part of the ACI Alliance study. Principal investigators Terry Zwolan PhD, Craig Buchman MD, and John Niparko MD led the multi-center study effort. Click here for more information on the expansion effort:

Decision Summary

The July 6 announcement can be found here.
In addition to the ACI Alliance request with related documentation, CMS conducted its own internal technology assessment. The Decision Summary includes reviews of published studies, a consensus statement, and a professional society guideline. Public comments provided further support for the expansion.

Support the Proposed Decision

American Cochlear Implant Alliance supports the proposed expansion criteria as presented in the July 6 Memo. There is an opportunity for 30 days (due date August 5) to comment. We encourage our members to provide a simple statement acknowledging the thorough work of CMS and supporting the expansion criteria decision as presented.  Click here for the comment area.

This is important news for the patient community and the clinicians who serve them! We are appreciative of the work of so many clinicians and researchers who contributed to this positive outcome.

Read more here .